Rabies

The Disease

Rabies is a severe viral infection transmitted to humans by the saliva of infected animals. Transmitted by being bitten, scratched or, less typically, being licked by the infected animal, the virus enters the body and attacks the nervous system. In developing countries, rabies is mainly transmitted by dogs and monkeys. However, it may also be passed on by bats, skunks, cats and foxes. Rabbits, squirrels, chipmunks, rats and mice are rarely infected, but any mammal with teeth theoretically can spread rabies.

Animal behaviour is NOT a reliable sign of whether an animal is rabid; an infected animal can appear normal. The disease’s incubation period can be as little as four days and as long as several years, averaging 3 -12 weeks.

Rabies affects the nervous system and the brain. Early symptoms include headache, fever, tiredness, pain, itching or tingling at the site of the healed bite wound. Later, a range of symptoms affecting the nervous system develop, including muscle spasms and an inability to drink and swallow, followed by paralysis, convulsions and coma. Untreated rabies is invariably fatal.

Where is it found?

Most countries throughout Asia, Africa and South America have extensive infected regions. Countries where rabies is a significant health risk include: Bangladesh, Bolivia, China, Colombia, Ecuador, El Salvador, Ethiopia, Guatemala, India, Mexico, Nepal, Peru, Philippines, Sri Lanka, Tanzania & Thailand.

Rabies is also present in developed countries, including those of Europe and North America (but not Australia or New Zealand). However, due to the high levels of immunisation the risk is lower. Many countries are free of Rabies, such as the UK, Japan and New Zealand.

Risk to travellers

Travellers to rabies-endemic countries should be aware of the risk. The best strategy to prevent Rabies is to avoid contact with any animal. However, pre-exposure vaccination is recommended for high-risk groups including animal handlers, veterinarians, naturalists, cave explorers, cyclists, and travellers to remote areas, particularly those spending more than 30 days travelling extensively in rural areas of high-risk countries. It is felt that the smaller stature of children puts them at higher risk of being bitten and there is a further risk that, having been warned not to make contact with animals, they may not report minor bites, scratches or licks.

All animal bites must be washed thoroughly with soap and water; alcohol or iodine may also be applied.

As Rabies is invariably fatal, urgent medical attention should be sought as soon as possible after any potential exposure for post-exposure vaccination to be administered.

Vaccination

Type:

• Inactivated viral vaccine.

Standard schedule:

• Three doses at 0, 7 and 28 days.
• If time does not permit standard schedule, an accelerated schedule of Days 0, 7 and 21 is possible.

Level of protection:

• For those people at risk due to occupational exposure, a blood test to check antibody levels is performed every 6 months (high risk) to 2 years and a booster given if the titres are low. Residents of endemic countries or regular travellers to those regions may receive a booster dose every two to three years.
• Pre-exposure vaccination does not eliminate the need for further treatment after a bite. However, it does allow more time to achieve appropriate post-exposure treatment (one week rather than 2 days) which comprises two post-exposure injections, rather than five or six. In addition, there is no need for rabies immunoglobulin (RIG), a blood-based product that is often in short supply in developing countries.

Possible side-effects:

Usually infrequent and mild:

• Redness, swelling, and pain around the injection site.
• Fever, headache, nausea, abdominal pain, muscle aches, dizziness.

As with all vaccines, there is a small risk of allergic reaction.

More information on this and related health risks will be available during your Travelvax consultation. Call 1300 360 164 for the location of your nearest clinic.